Risk Reduction in Action: A Man's Story of Sex Work (as Told to His Counselor)

By Norman Medina

November 15, 2010

For our World AIDS Day 2010 section, we wanted to capture the diversity of the AIDS community. So, we reached out to people across the world -- mostly those who have never written for us before -- and asked them to guest blog. These columns are written by people who are living with HIV, have been affected by HIV, or work in the field.

Norman Medina

Preventing HIV is a challenge that transcends national borders. As an organization that serves Latinos, the main challenge faced by GALAEI [Gay and Lesbian Latino AIDS Education Initiative] is to target and reach Philadelphia's LGBTQ immigrants. We offer a safe place for them to learn about HIV and educate them on prevention. We work to adapt the prevention information to the unique circumstances of our community. Our outreach is sensitive to an immigrant culture where people may not identify as gay. We have learned that many male immigrants have sex with other men but don't identify with gay culture. We have adapted our tools and materials to reach them and accept them as they are. At the same time, we continue to engage in prevention work with other immigrants who self-identify as gay and for whom a gay prevention message is necessary and appropriate.We know that prevention work is only successful when it results in behavior change. We carefully monitor our message and its impact on behavior. We use these data to inform and refine our service delivery model.

The first time I had a client who was engaged in sex work was a new and enriching experience in many ways -- from learning about the dynamics, language and activities of the worker and the meaning this experience represented to him, to the questions he asked, which gave me guideline for investigating more closely the concept of sexual risk perception along with personal history as a son, brother, uncle and lover.

So there he was, first customer of the day -- I'll call him "Hunk." He was in for an HIV test, and I could tell he was nervous as he filled out the forms and prepared for the test. The idea of dropping out and leaving was there when I invited him to complete the form together if he had any concerns or questions.

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When we entered to the counseling room, the first thing he said was that he was very nervous reading the questions on the form. From the risks he was engaging in, he said, he could have been exposed to HIV many times. It was then he confessed to being a sex worker.

While developing the test and waiting for the results, I talked to Hunk about his experiences, his customers and the activities they asked for. He told me he'd been surprised that they asked for different things and didn't always want to have sex, and he wondered if that was normal, because he expected every time he got a customer that they would require penetrative sex.

This was an opportunity to explain that sexuality is an open book with no end, and evolving. The tastes that people have are not just limited to certain common sexual activities, and in the search to find pleasure there are different roads they can take. There's nothing we can say is "normal" or not; and to express my views even further on that, there isn't even the need to use this term "normal."

Hunk's test result came: He was HIV negative. He was a little bit relieved, but still had questions and wanted to talk more. Because of that I continued with my own questions. I told him I was interested to know what it means to him to be a sex worker, what are their goals, and how did he end up doing this work.

I also asked him if anyone knew he was coming to be tested and if he had an emotionally close person or a family member. He told me that his family lived out of town, and that he did not have much contact with them since the death of his mother when he was a teenager. He had a poor relationship with his father and brothers, developed over many years of living far away from one another. When he first moved to this area, his artistic experience led him to travel to many places, including Europe -- until he fell in love and decided to move to the other side of the country. As he describes, the excitement was short-lived. When he got back and tried to pick up where he left off, there was no space for him in the group to which he once belonged.

He moved to a friend's house and started to look for work, with no luck at all. He didn't know where to go -- until his friend told him to do anything, including prostitution, to get money. Hunk thought about it more than a thousand times. Then one day he went walking down the street and a car pulled up beside him and offered him a ride. Hunk said no -- but then the person in the car asked if Hunk would let him suck his cock, and told him he could pay for it. Hunk smiled and said, "What about 50 bucks?" The customer actually said "Deal!"

Now Hunk had a small income from this person, who required his services up to four times a week. Hunk's friend told him he could get more than that if he promoted himself on the Internet. After doing that, proposals came without stopping. Hunk went to serve his clients at parties, in saunas, at hotels -- often the sex involved more than one person, and it was often unprotected. Hunk said he never felt the need to ask for a condom unless the customer requested it.

After getting to know Hunk better, I told him about the CRCS [Comprehensive Risk Counseling and Services] program and asked if he'd be interested in participating. After he recognized the risks he was taking, we could work together to reduce them. I also gave him a referral to testing for other STDs [sexually transmitted diseases].

When Hunk started the CRCS sessions he was quite willing to do anything to learn more and participate in other groups. We also started working on developing a risk-reduction plan, with the ultimate goal of using a condom all the time and reducing his number of sexual partners. I explained that it would be gradual and that together we could do it

The first few weeks he attempted to make a change, but nothing worked. We practiced role-playing to negotiate condom use, but in the end Hunk did whatever the customers ordered. He had to do it so as not to run out of money -- especially now that he was living alone.

Most of the clients who did not use condoms were Hunk's regular customers; a smaller percentage of new customers or people visiting the city were the ones who used them. After continually failing to negotiate with regular customers, Hunk and I did a count of his customers and the activities they requested of him. Then we began sorting out administrative options so that he could continue providing services without losing customers or exposing himself to HIV.

After evaluating the process, it became clear that the product that he was selling was himself, and the product needed to be in good condition in order to continue. So we decided to add value to his services, first identifying the customers who allowed a condom or asked for something other than sex -- such as mutual masturbation, massage or peeing on the client. The idea was give his services a variation that allows the customer to pay more and require more services over time. For example when talking sensual massage saying that customer that has good body and likes to touch, when mutual masturbation make it clear that he likes what they do and to refrain from ejaculating so that the customer then ejaculates he can ask again and promise to do ejaculate, customers who liked to be urinated or something else, talk loud or use hard words, All this new stuff would make the customers come back even sooner. This new way of doing services worked! This way, Hunk was able to make enough money to discard clients that could be putting him at risk.

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The results of Hunk's tests for other STDs also came back negative, and he considered himself blessed to not have caught anything. Today I can say that Hunk is a master in the use of condoms, dental dams and flavored condoms for oral sex with clients.

Over the next year, in addition to achieving his goals, Hunk continued sharing his own experiences with others in similar positions, and enjoyed participating in discussion groups and community activities to help stop the spread of STDs and HIV. With each visit he'd learn something new and was pleased to continue on the path he'd taken. To this day, Hunk still gets tested every three months.

Hunk was happy with the results he'd achieved, and participating in the community helped him to feel prepared for the next steps in his life, so we revisited his family history. I could see the sparkle of desire in his eyes when we talked about the possibility of his meeting with them, and how it might go. He traveled to another state to visit his family with great emotion and with nothing to fear.

It made me worry that I didn't hear from him from Thanksgiving until Christmas. When we spoke, he told me his entire adventure in detail: The family received him very well, and the dialogue with his father and brothers helped them to apologize and want to reestablish communication. He did not share where it is he works, but he did tell his family about his involvement in community work and everything he has learned. He even had a special conversation with one of his nephews who is gay, whose mother was worried about it but still wanted to give support.

The emotion that I saw on him showed how good and healing it was to see his family. He said he would like to return to their area but had no idea what he could do. I asked him what businesses or activities his family members had or managed, and if he thought he could do some of that. It turned out that his brother had a towing business and a garage, and his brother told him that maybe they could work together. His father was also elderly and lived alone, and perhaps he needed attention from someone living there.

I repeated back to Hunk what he'd told me, to show him what possibilities there were for him. The only thing he had to do was make a decision, and it didn't have to be right at that moment. I reminded him how, little by little, he'd achieved his risk-reduction goals, and in the same way we could develop a plan to see if it was feasible to move closer to his family.

Visits increased to see his family. While there one summer weekend, he met a young man who made a little impression, and for the first time in a long time he felt the call of love. Hunk told him all about his life; and now he felt he could leave it behind and start again.

Weeks later, Hunk came into my office with his new love, "Richard," to say goodbye: He would go where his family was, and continue his relationship with Richard. He thanked me and told me that I saved his life -- but I made clear to him that all his achievements were because he wanted them.

I cannot deny the immense emotion that came over me after seeing them together. I was glad to hear that they had each other, as well as being well. Hunk left sex work, recovered his communication with his family and found love, and as of today he tells me he's HIV negative, with no STDs, and is always next to Richard.

This story might sound weird, but it's real. Hunk came into my office two years ago to get tested -- nervous and not knowing what the result was going to be. His life has changed completely -- same as the lives of others, whether less or more fortunate, who have achieved their goals because they wanted to.
This is a story for the Hunks that I work with, and for those to come: If the road seems too long, taking the first step is enough to accomplish dreams -- and there is always a hand on the other side waiting for you.

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